NCCN Guidelines® Insights: Hodgkin Lymphoma, Version 2.2022

Featured Updates to the NCCN Guidelines

Authors:
Richard T. Hoppe Stanford Cancer Institute;

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Ranjana H. Advani Stanford Cancer Institute;

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Weiyun Z. Ai UCSF Helen Diller Family Comprehensive Cancer Center;

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Richard F. Ambinder The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

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Philippe Armand Dana-Farber/Brigham and Women’s Cancer Center;

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Celeste M. Bello Moffitt Cancer Center;

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Cecil M. Benitez UCLA Jonsson Comprehensive Cancer Center;

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Weina Chen UT Southwestern Simmons Comprehensive Cancer Center;

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Bouthaina Dabaja The University of Texas MD Anderson Cancer Center;

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Megan E. Daly UC Davis Comprehensive Cancer Center;

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Leo I. Gordon Robert H. Lurie Comprehensive Cancer Center of Northwestern University;

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Neil Hansen Fred & Pamela Buffett Cancer Center;

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Alex F. Herrera City of Hope National Medical Center;

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Ephraim P. Hochberg Massachusetts General Hospital Cancer Center;

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Patrick B. Johnston Mayo Clinic Cancer Center;

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Mark S. Kaminski University of Michigan Rogel Cancer Center;

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Christopher R. Kelsey Duke Cancer Institute;

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Vaishalee P. Kenkre University of Wisconsin Carbone Cancer Center;

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Nadia Khan Fox Chase Cancer Center;

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Ryan C. Lynch Fred Hutchinson Cancer Research Center/University of Washington;

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Kami Maddocks The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

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Jonathan McConathy O'Neal Comprehensive Cancer Center at UAB;

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Monika Metzger St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center;

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David Morgan Vanderbilt-Ingram Cancer Center;

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Carolyn Mulroney UC San Diego Moores Cancer Center;

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Sheeja T. Pullarkat UCLA Jonsson Comprehensive Cancer Center;

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Rachel Rabinovitch University of Colorado Cancer Center;

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Karen C. Rosenspire Abramson Cancer Center at the University of Pennsylvania;

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Stuart Seropian Yale Cancer Center/Smilow Cancer Hospital;

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Randa Tao Huntsman Cancer Institute at the University of Utah;

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Pallawi Torka Roswell Park Comprehensive Cancer Center;

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Jane N. Winter Robert H. Lurie Comprehensive Cancer Center of Northwestern University;

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Joachim Yahalom Memorial Sloan Kettering Cancer Center;

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Joanna C. Yang Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and

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Jennifer L. Burns National Comprehensive Cancer Network.

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Mallory Campbell National Comprehensive Cancer Network.

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Hema Sundar National Comprehensive Cancer Network.

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Hodgkin lymphoma (HL) is an uncommon malignancy of B-cell origin. Classical HL (cHL) and nodular lymphocyte–predominant HL are the 2 main types of HL. The cure rates for HL have increased so markedly with the advent of modern treatment options that overriding treatment considerations often relate to long-term toxicity. These NCCN Guidelines Insights discuss the recent updates to the NCCN Guidelines for HL focusing on (1) radiation therapy dose constraints in the management of patients with HL, and (2) the management of advanced-stage and relapsed or refractory cHL.

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    Paumier A, Ghalibafian M, Gilmore J, et al. Dosimetric benefits of intensity-modulated radiotherapy combined with the deep-inspiration breath-hold technique in patients with mediastinal Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys 2012;82:15221527.

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    Filippi AR, Ragona R, Fusella M, et al. Changes in breast cancer risk associated with different volumes, doses, and techniques in female Hodgkin lymphoma patients treated with supra-diaphragmatic radiation therapy. Pract Radiat Oncol 2013;3:216222.

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    Filippi AR, Ciammella P, Piva C, et al. Involved-site image-guided intensity modulated versus 3D conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2014;89:370375.

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    Voong KR, McSpadden K, Pinnix CC, et al. Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma. Radiat Oncol 2014;9:94.

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    Specht L, Yahalom J, Illidge T, et al. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys 2014;89:854862.

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    van Nimwegen FA, Ntentas G, Darby SC, et al. Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines. Blood 2017;129:22572265.

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  • 22.

    Wright JL, Yom SS, Awan MJ, et al. Standardizing normal tissue contouring for radiation therapy treatment planning: an ASTRO consensus paper. Pract Radiat Oncol 2019;9:6572.

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  • 23.

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    Hoppe BS, Bates JE, Mendenhall NP, et al. The meaningless meaning of mean heart dose in mediastinal lymphoma in the modern radiation therapy era. Pract Radiat Oncol 2020;10:e147154.

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    Maraldo MV, Giusti F, Vogelius IR, et al. Cardiovascular disease after treatment for Hodgkin’s lymphoma: an analysis of nine collaborative EORTC-LYSA trials. Lancet Haematol 2015;2:e492502.

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  • 27.

    van Nimwegen FA, Schaapveld M, Cutter DJ, et al. Radiation dose-response relationship for risk of coronary heart disease in survivors of Hodgkin lymphoma. J Clin Oncol 2016;34:235243.

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    Schellong G, Riepenhausen M, Bruch C, et al. Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 2010;55:11451152.

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    Moignier A, Broggio D, Derreumaux S, et al. Coronary stenosis risk analysis following Hodgkin lymphoma radiotherapy: a study based on patient specific artery segments dose calculation. Radiother Oncol 2015;117:467472.

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    Hahn E, Jiang H, Ng A, et al. Late cardiac toxicity after mediastinal radiation therapy for Hodgkin lymphoma: contributions of coronary artery and whole heart dose-volume variables to risk prediction. Int J Radiat Oncol Biol Phys 2017;98:11161123.

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  • 33.

    Atkins KM, Chaunzwa TL, Lamba N, et al. Association of left anterior descending coronary artery radiation dose with major adverse cardiac events and mortality in patients with non-small cell lung cancer. JAMA Oncol 2021;7:206219.

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  • 38.

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    Straus DJ, Długosz-Danecka M, Alekseev S, et al. Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study. Blood 2020;135:735742.

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    Straus DJ, Długosz-Danecka M, Connors JM, et al. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. Lancet Haematol 2021;8:e410421.

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    Borchmann P, Goergen H, Kobe C, et al. PET-guided treatment in patients with advanced-stage Hodgkin’s lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet 2017;390:27902802.

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    Casasnovas RO, Bouabdallah R, Brice P, et al. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol 2019;20:202215.

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  • 47.

    Hutchings M, Radford J, Ansell SM, et al. Brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine in patients with advanced-stage, classical Hodgkin lymphoma: a prespecified subgroup analysis of high-risk patients from the ECHELON-1 study. Hematol Oncol 2021;39:185195.

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    Gopal AK, Press OW, Shustov AR, et al. Efficacy and safety of gemcitabine, carboplatin, dexamethasone, and rituximab in patients with relapsed/refractory lymphoma: a prospective multi-center phase II study by the Puget Sound Oncology Consortium. Leuk Lymphoma 2010;51:15231529.

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    Moskowitz AJ, Hamlin PA Jr, Perales MA, et al. Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol 2013;31:456460.

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    Fehniger TA, Larson S, Trinkaus K, et al. A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood 2011;118:51195125.

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    Gopal AK, Chen R, Smith SE, et al. Durable remissions in a pivotal phase 2 study of brentuximab vedotin in relapsed or refractory Hodgkin lymphoma. Blood 2015;125:12361243.

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    Garcia-Sanz R, Sureda A, Alonso-Alvarez S, et al. Evaluation of the regimen brentuximab vedotin plus ESHAP (BRESHAP) in refractory or relapsed Hodgkin lymphoma patients: preliminary results of a phase I-II trial from the Spanish Group of Lymphoma and Bone Marrow Transplantation (GELTAMO) [abstract]. Blood 2015;126:Abstract 582.

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    Moskowitz AJ, Schöder H, Yahalom J, et al. PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosfamide, carboplatin, and etoposide for patients with relapsed and refractory Hodgkin’s lymphoma: a non-randomised, open-label, single-centre, phase 2 study. Lancet Oncol 2015;16:284292.

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    LaCasce AS, Bociek RG, Sawas A, et al. Brentuximab vedotin plus bendamustine: a highly active first salvage regimen for relapsed or refractory Hodgkin lymphoma. Blood 2018;132:4048.

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    O’Connor OA, Lue JK, Sawas A, et al. Brentuximab vedotin plus bendamustine in relapsed or refractory Hodgkin’s lymphoma: an international, multicentre, single-arm, phase 1-2 trial. Lancet Oncol 2018;19:257266.

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  • 67.

    Ansell SM, Lesokhin AM, Borrello I, et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin’s lymphoma. N Engl J Med 2015;372:311319.

  • 68.

    Younes A, Santoro A, Shipp M, et al. Nivolumab for classical Hodgkin’s lymphoma after failure of both autologous stem-cell transplantation and brentuximab vedotin: a multicentre, multicohort, single-arm phase 2 trial. Lancet Oncol 2016;17:12831294.

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    Armand P, Engert A, Younes A, et al. Nivolumab for relapsed/refractory classic Hodgkin lymphoma after failure of autologous hematopoietic cell transplantation: extended follow-up of the multicohort single-arm phase II CheckMate 205 trial. J Clin Oncol 2018;36:14281439.

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  • 70.

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